Attention-Deficit/Hyperactivity Disorder and Outcome from Concussion: Examining Duration of Active Rehabilitation and Clinical Recovery

Abstract

Aims

The objective of this study was to compare recovery time and duration of active rehabilitation following concussion between adolescents with and without attention-deficit/hyperactivity disorder (ADHD).

Methods

A retrospective cohort study was conducted among adolescents presenting to a specialty concussion clinic. One-quarter of the eligible episodes of care were selected. The final sample included 540 adolescents (ages 13–17 years, median age 15 years; 49.8% girls), of which 65 (12.0%) had a pre-injury diagnosis of ADHD. Days to recovery and days of active rehabilitation were examined.

Results

ADHD was not associated with recovery time (ADHD: median = 49 days, IQR = 25–77; No ADHD: median = 47 days, IQR = 29–85) in univariate (Z = −0.45; p = 0.65) or multivariable analyses (Hazard Ratio: 1.17 (0.85–1.61); χ²(1) = 0.95; p = 0.33). The duration of active rehabilitation services received did not differ between youth with ADHD (median = 38.5 days, IQR = 27.5–54.5) and without ADHD (median = 37.5 days, IQR = 18.5–66) in univariate (Z = −0.19; p = 0.85) or multivariable analyses (Hazard Ratio: 1.04 (0.67–1.63); χ²(1) = 0.03; p = 0.85).

Conclusions

Our findings support accumulating evidence that ADHD, in and of itself, is not a risk factor for longer recovery or worse outcomes following pediatric concussion.

Keywords:

• ADHD
• concussion
• mild traumatic brain injury
• brain trauma
• outcome research
• prognosis
• duration of rehabilitation

Disclosure statement

Grant Iverson serves as a scientific advisor for NanoDx™, Sway Operations, LLC, and Highmark, Inc. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has a clinical and consulting practice in forensic neuropsychology involving individuals who have sustained mild TBIs. Drs. Cook and Teel wrote the first draft of the manuscript. No honorarium, grant, or other form of payment was given to anyone to produce the manuscript.

Additional information

Funding

Nathan Cook acknowledges support from the Louis V. Gerstner III Research Scholar Award. The authors have received funding from the National Football League for a program of research entitled “The Spectrum of Concussion: Predictors of Clinical Recovery, Treatment and Rehabilitation, and Possible Long-Term Effects” (Principal Investigator Iverson). One aim of this research program is to develop and evaluate home-based active rehabilitation for concussion. The funders were not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication. In addition, Grant Iverson acknowledges past unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, the National Rugby League, and the Spaulding Research Institute.

Notes on contributors

Nathan E. Cook

Nathan E. Cook, Ph.D. is an Assistant Professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. He is a Pediatric Neuropsychologist at the MassGeneral Hospital for Children Sports Concussion Program in Boston, Massachusetts, USA.

Elizabeth Teel

Elizabeth Teel, Ph.D. is a Postdoctoral Fellow in the School of Physical and Occupational Therapy at McGill University in Montreal, Quebec, Canada.

Grant L. Iverson

Grant L. Iverson, Ph.D. is a Professor in the Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital and Harvard Medical School. He is the Director of the Concussion Research Program for the Spaulding Research Institute. He is the Director of the MassGeneral Hospital for Children Sports Concussion Program in Boston, Massachusetts, USA.

Deborah Friedman

Deborah Friedman, BSc, pht, M Mgmt is an Associate Professor in the Departments of Pediatrics & Pediatric Surgery, an Assistant Dean of Student Affairs and Co-Director of the WELL Office in the Faculty of Medicine & Health Sciences at McGill University in Montreal Quebec. She is also the Director of Trauma and the Director of the Canadian Hospitals Injury Reporting Prevention Program at the Montreal Children’s Hospital McGill University Health Centre Trauma Centre in Montreal, Quebec.

Lisa Grilli

Lisa Grilli, MSc, pht is a trauma coordinator in the Mild Traumatic Brain Injury Clinic and Trauma Research Program at the Montreal Children’s Hospital of the McGill University Health Center in Montreal.

Isabelle Gagnon

Isabelle Gagnon, PT, PhD is an Associate Professor in the School of Physical and Occupational Therapy at McGill University. She is a clinician-scientist at the Montreal Children’s Hospital of the McGill University Health Center in Montreal, where she is also an Associate Director (Research) in the Division of Pediatric Emergency Medicine.